Antidiabetic Prescription Research Articles

Risk stratification for cardiovascular disease based on prior coronary artery disease, cerebrovascular disease and type 2 diabetes mellitus.

History of coronary artery disease (CAD), cerebrovascular disease (CeVD), type 2 diabetes and their combined effect on cardiovascular disease are essential for cardiovascular risk management. We investigated the association of prior CAD, prior CeVD, type 2 diabetes and their combination with the risk of cardiovascular disease. This is a historical cohort study including 342,033 participants (aged 18-72 years) followed up for ≥5 years between 2008 and 2016. Participants were classified into eight groups (with or without prior CAD, prior CeVD and type 2 diabetes). Type 2 Diabetes was defined by fasting plasma glucose and glycated hemoglobin levels, and antidiabetic drug prescription. Prior and subsequent CAD and CeVD were identified according to claims using International Classification of Diseases 10th Revision codes, medical procedures and questionnaires. Cox regression models were used to evaluate the risk of cardiovascular events. The median follow-up period was 6.4 years. The incidence of composite cardiovascular events of CAD and CeVD in the CAD-/CeVD-, CAD+/CeVD-, CAD-/CeVD+ and CAD+/CeVD+ groups were 1.92 and 6.94, 25.14 and 31.98 per 1,000 person-years in non-diabetes participants, and 8.66, 18.04, 39.98 and 60.72 in type 2 diabetes patients, respectively. Hazard ratios of cardiovascular events compared with CAD-/CeVD-/non-diabetes were 1.66 (95% confidence interval 1.55-1.78) in CAD-/CeVD-/type 2 diabetes and 1.84 (1.56-2.18) in CAD+/CeVD-/non-diabetes. CeVD+ was linked to a 4-7-fold increase in the risk of cardiovascular events regardless of CAD+ or type 2 diabetes. Type 2 diabetes increased the risk of cardiovascular disease as high as a history of CAD, whereas prior CeVD alone increased the risk of future CeVD without additional effects by type 2 diabetes.

Levels of plasma 25-hydroxy vitamin D and risk of developing type 2 diabetes in a large Danish primary health care population.

Plasma levels of Vitamin D (25(OH)D) have been suggested as a predictor for developing type 2 diabetes. The purpose of this study was therefore to investigate if a measurement of plasma 25(OH)D could predict the development of type 2 diabetes in a cohort of 222,311 individuals from primary healthcare in Denmark. The CopD-study database containing data from the Copenhagen General Practitioners Laboratory on blood tests conducted from April 2004 to January 2012 was used for identification of the study population. Incident type 2 diabetes was then defined as having at least two redeemed prescriptions of antidiabetics or at least two hospital contacts due to type 2 diabetes or one redeemed prescription and one hospital contact regarding type 2 diabetes. A total of 222,311 individuals were included in the study, of whom 7652 (3.4%) developed type 2 diabetes during the follow-up period of minimum one year. Individuals who developed type 2 diabetes had a significantly lower median 25(OH)D level than persons in the non-diabetes group. The hazard ratio for development of type 2 diabetes increased by 15% per 10nmol/L decrease in 25(OH)D level. In this study of 222,311 persons from primary health care in Denmark, we found a clear inverse relationship between 25(OH)D and the risk of developing type 2 diabetes. Further studies should be conducted to clarify the mechanisms behind the relationship between 25(OH)D and type 2 diabetes and the effect of oral vitamin D supplementation on the development of type 2 diabetes.

The Prescription and Safety of Oral Antidiabetic Drugs in Outpatients with Type 2 Diabetes Mellitus: An Observational, Retrospective, Multicenter Study on the Role of Adherence in a Real-Life Primary Care Setting

Introduction: Type 2 diabetes mellitus (T2DM) is a common disease burdened with significant morbidity and mortality. Despite the substantial number of new available drug treatments, adherence to therapy and adverse drug reactions (ADRs) are the major constraint in the management of this disease. We evaluated the use, the adherence, and the safety of antidiabetic drugs in patients with T2DM. Methods: We performed an observational, retrospective, multicenter study on medical records of outpatients referred to general practitioners in Catanzaro (Calabria, Italy). Drug adherence was measured considering the packages of antidiabetic drugs prescribed at the time of admission, after three months, and 1 year later. ADRs were evaluated using the Naranjo probability scale. Collected data were analyzed using the Statistical Package for the Social Sciences. Results: During the study, we evaluated 12,170 medical records of seven general practitioners. The most prescribed drug was metformin alone (28.4%) or with other oral antidiabetics (19.6%) and then insulin (n: 354; men 190, women 164). Logistic regression showed an association between T2DM less than or equal to 5 years and low adherence (p = 0.023). During the study, we recorded 26 ADRs that were correlated with sex (women) and insulin treatment. Conclusions: this real-life study shows that patients with T2DM have a high adherence, probably related to their having a low number of ADRs.

Brief communication: temporal trends of chronic diseases medications prescriptions among HIV-infected patients in Belgium: a 4-year population-based study using pharmacy claims data

The Objective of this study was to examine change over time of prevalence of chronic diseases medications (CDM) prescriptions among People living with HIV (PLWH) in Belgium, using Pharmanet database from 2018 to 2021. We identified 13,570, 14,175, 14,588 and 14,813 PLWH in 2018, 2019, 2020 and 2021, respectively. Prescriptions of cardiovascular diseases (CVD) medications (31.7–37.2%) and antidiabetics (7.4–9.0%), increased significantly (p for trend < 0.001 for all), while the prescription of neurological and mental disorders medications (18.0–19.3%) remained stable (p for trend = 0.11) and the prescription of chronic respiratory diseases (CRD) medications decreased from 12.2 to 10.6% (p for trend < 0.001), between 2018 and 2021. It is imperative to ensure that these medications are used appropriately.

1885-LB: Status of Irrational Prescription of Oral Antidiabetic Drugs (OADs) Based on eGFR in Elderly Type 2 Diabetes Patients and the Related Affecting Factors

1885-LB: Status of Irrational Prescription of Oral Antidiabetic Drugs (OADs) Based on eGFR in Elderly Type 2 Diabetes Patients and the Related Affecting Factors

Investigating the effect of prescribing status and patient characteristics on the therapeutic outcomes in patients with diabetes using a leftover drug adjustment protocol.

Treatment for diabetes includes anti-diabetic medication in addition to lifestyle improvements through diet and exercise. In Japan, protocol-based pharmacotherapy management allows drug treatment to be provided through cooperation between physicians and pharmacists, based on a protocol that is prepared and agreed upon in advance. However, there are no studies to clarify the relationship between patient characteristics and therapeutic effects after pharmacist intervention in protocol-based pharmacotherapy management for patients with diabetes. Therefore, this study aimed to use protocol-based reports from pharmacies to understand the status of outpatient diabetes medication compliance. We classified patients with diabetes on the basis of patient characteristics that can be collected in pharmacies and investigated the characteristics that impacted diabetes treatment. Patients were prescribed oral anti-diabetic drugs at outpatient clinics of Hitachinaka General Hospital, Hitachi, Ltd., from April 2016 to March 2021. Survey items included patient characteristics (sex, age, number of drugs used, observed number of years of anti-diabetic drug prescription, number of anti-diabetic drug prescription days, and presence or absence of leftover anti-diabetic drugs) and HbA1c levels. Graphical analyses indicated the relationship between each categorised patient characteristic using multiple correspondence analyses. Subsequently, the patients were clustered using K-means cluster analysis based on the coordinates obtained for each patient. Patient characteristics and HbA1c values were compared between the groups for each cluster. A total of 1,910 patients were included and classified into three clusters, with clusters 1, 2, and 3 containing 625, 703, and 582 patients, respectively. Patient characteristics strongly associated with Cluster 1 were ages between 65 and 74years, use of three or more anti-diabetic drugs, use of 3years or more of anti-diabetic drugs, and leftover anti-diabetic drugs. Furthermore, Cluster 1 had the highest number of patients with worsening HbA1c levels compared with other clusters. Using the leftover drug adjustment protocol, we clarified the patient characteristics that affected the treatment course. We anticipate that through targeted interventions in patients exhibiting these characteristics, we can identify those who are irresponsibly continuing with drug treatment, are not responding well to therapy, or both. This could substantially improve the efficacy of their anti-diabetic care.

A Study on Autonomic Dysfunction in Type 2 Diabetes Mellitus with Peripheral Neuropathy

Abstract Introduction: Subclinical Autonomic Neuropathy is found in association with distal symmetric polyneuropathy in diabetic patients. The Aim of this study was to compare the Cardiac Autonomic Function Test parameters in Type 2 Diabetes Mellitus patients with and without Distal Peripheral Neuropathy. The Primary Objective was to compare the mean of Valsalva ratio in Type 2 Diabetes Mellitus patients with and without Distal Peripheral Neuropathy. The secondary Objective of this study was to find the correlation between Michigan Neuropathic Screening Instrument Score and Autonomic Function test parameters in type 2 Diabetes Mellitus patients. Methods: This was a single centre, cross sectional study conducted from July 2022 to Feb 2023. The study was commenced after obtaining Institute Ethics Committee clearance. Subjects who satisfied the inclusion and exclusion criteria, and gave informed consent for participation in this study were eligible for enrolment. The inclusion Criteria were patients aged between 18 and 65 years with diagnosis of Diabetes mellitus. The number required to study Diabetic patients with peripheral neuropathy was 34 and for Diabetic patients without peripheral neuropathy was 34. Total sample size of 68 patients was taken. Once the patient was enrolled a detailed history, clinical examination, ANS testing and MSNI scoring was done as per attached pre verified proforma duly vetted by institutional scientific committee.Patients were asked to refrain from vigorous exercise for the 24 hours before to the cardiovascular testing as well as from eating, drinking, or smoking for at least 2 hours before the autonomic testing. At the conclusion of the checkup, all antidiabetic and other prescriptions were given. After data collection, test for normality of data was done. Appropriate statistical tests were applied according to data distribution and analysed by using SPSS criteria 2011. Results: A total of 68 patients, 34 with symptoms of Diabetic Peripheral Neuropathy and 34 without Diabetic Peripheral Neuropathy were studied from July 2022 to December 2023. The age, BMI, duration of disease, HbA1c, resting systolic blood pressure and heart rate didn’t show any significant difference between the two groups and thus the groups were comparable. The median (interquartile range) of MNSI score of diabetic patients without neuropathy was 1(1,1) and diabetic patients with neuropathy was 8 (7,9) with p value &lt; 0.005. There was a significant difference in E: I ratio (P&lt;0.0001) between diabetic patients with and without neuropathy. The mean ± SD of Valsalva ratio, in diabetic patients without neuropathy was 1.632 ± 0.115 and with neuropathy was 1.366 ± 0.045. There was a significant difference in Valsalva ratio (P&lt;0.0001). There was a good negative correlation between MNSI score and Valsalva ratio with r= -0.769 and p value &lt; 0.0001 in Type 2 Diabetes mellitus patients. Conclusion: This study found that the Cardiac Autonomic Function Test parameters in Type 2 Diabetes Mellitus patients with and without Distal Peripheral Neuropathy, were significantly deranged in patients with symptomatic DPN. The mean of Valsalva ratio was significantly different in two study groups. The correlation between Michigan Neuropathy Screening Instrument Score and Autonomic Function test parameters in Type 2 Diabetes Mellitus patients showed strong negative correlation. The patients with symptomatic DSN were found to have higher MSNI scores, who in turn were having severe cardiac autonomic dysfunction. Recommendation of Study: Mean Valsalva ratio and MNSI testing are recommended to be used as a screening tool to assess cardiac autonomic functions as a low cost tool in patients of T2DM having symptoms suggestive of DSN.

Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes.

Type 2 diabetes (T2D) is a major risk factor for carpal tunnel syndrome (CTS) and trigger finger (TF), but less is known regarding the risk of developing T2D after being diagnosed with CTS or TF. CTS and TF could be early signs of preclinical T2D, and early detection of T2D is crucial to prevent complications and morbidity. Therefore, we investigate the association between CTS/TF and T2D in an adult population without previous T2D using big data registers in Sweden. Data were collected by crosslinking five nationwide Swedish registers. Individuals aged 40-85 years on December 31, 2010, without prior overt diabetes, were included (n = 3,948,517) and followed up from baseline (ie, a diagnosis of CTS or TF) or January 1, 2011, for controls, until a diagnosis of T2D, prescription of oral antidiabetics or insulin, or end of follow-up four years after baseline. Multivariate Cox regression models were created to calculate hazard ratios for T2D. In total, 37,346 (0.95%) patients were diagnosed with CTS, whereof 1329 (3.46%) developed T2D. There were 17,432 (0.44%) patients who developed TF, whereof 639 (3.67%) developed T2D. Among the controls, 2.73% developed T2D. Compared with controls, there was an increased risk of developing T2D after being diagnosed with either CTS (HR 1.35; 95% confidence interval 1.28-1.43) or TF (HR 1.21; 95% confidence interval 1.12-1.31). Compared with controls, a diagnosis of CTS or TF was associated with 35% and 21% higher risk for later T2D, respectively, which might indicate the existence of undetected T2D in this population.

#209 Relation between exercise pattern changes and renal outcome in new-onset diabetes: a nationwide population-based study

Abstract Background and Aims Exercise reduced risk of diabetes and obesity. However, it remains unclear whether the pattern changes of exercise are increased risk of end-stage renal disease in new-onset diabetes mellitus (DM) patients. Method We assessed diabetes development in 2015 in 21,122,422 non-diabetic Koreans enrolled in Korean National Health Screening (KNHS) from 2009 to 2012 using International Classification of Diseases 10th (ICD-10) code and anti-diabetic medication prescription. Renal outcome (End-stage renal disease) was defined using V-code. The risk of ESRD evaluated in never exercise (none), after new-onset DM (post only), before new-onset DM and no exercise after new-onset DM (pre-only) and persistent exercise group (persistent group). Results During median 4.8-year follow-up, 275 (0.21%) of ESRD was occurred. After fully adjusted, the hazard ratio (HR) for ESRD was lowest in persistent exercise group 0.521 [0.302 to 0.899]. Post only exercise 0.674 [0.461 to 0.985] group showed better renal outcome compared to pre only exercise group 0.791 [0.535 to 1.169] or never exercise group [reference, 1.0]. Subgroup analysis for age, sex, history of chronic kidney disease, hypertension showed similar results. Even light exercise such as walking tended to reduce the risk of renal outcome 0.817 [0.634 to 1.037]. The higher 0.627 [0.441 to 0.892] or moderate 0.7 [0.514 to 0.953] strength of exercise type showed the lower risk of renal outcome in new-onset DM patients. Conclusion This study provides compelling evidence that exercise, particularly when maintained over time, is associated with a substantial reduction in the risk of ESRD in individuals with new-onset DM. These findings underscore the importance of incorporating regular physical activity as a crucial component of comprehensive health management strategies for individuals with diabetes, offering both clinicians and patients valuable insights for optimizing renal outcomes.

Medication use before and after bariatric surgery: 5-year results from a randomised controlled trial of banded Roux-en-Y gastric bypass versus sleeve gastrectomy in patients with obesity and type 2 diabetes.

Bariatric surgery is an effective tool for weight loss and for improving weight related co-morbidities. Changes in medication usage after a silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) are unknown. This was a single-centre, double-blind, randomised controlled trial. Patients were randomised to either SR-LRYGB or LSG. A medication history was obtained at regular follow-up intervals, and mean numbers of prescribed medications were analysed over 5 years. Poisson regression and generalised estimating equations were used to test for statistically significant changes in usage. After eight patients were lost to follow-up, data from 52 patients in each group were available for analysis. There was no difference between the SR-LRYGB or LSG groups in the number of medications prescribed, with the exception of oral glucose-lowering medications, where there was a greater decrease after SR-LRYGB compared to LSG (79% vs 55% respectively) from baseline to 5 years. At 5 years, total medication prescribed was down 10% from pre-operative levels. Prescribed insulin decreased by 72%, and cardiovascular medication decreased by 56% compared to baseline. Prescriptions for analgesia increased by 50%, psychiatric medications by 133% and proton-pump inhibitors by 81%. Both SR-LRYGB and LSG reduced requirement for diabetic and cardiovascular medications, but increased requirement for nutritional supplementation, analgesia and psychiatric medications. There was a greater reduction in oral anti-diabetic medication prescriptions following SR-LRYGB compared to LSG, but no other difference in medication usage between surgical groups was found.

The cost of influence: How gifts to physicians shape prescriptions and drug costs

This paper investigates the influence of gifts – monetary and in-kind payments – from drug firms to US physicians on prescription behavior and drug costs. Using causal models and machine learning, we estimate physicians’ heterogeneous responses to payments on antidiabetic prescriptions. We find that payments lead to increased prescription of brand drugs, resulting in a cost rise of $23 per dollar value of transfer received. Paid physicians show higher responses when they treat higher proportions of patients receiving a government-funded low-income subsidy that lowers out-of-pocket drug costs. We estimate that introducing a national gift ban would reduce diabetes drug costs by 2%.

Non-adherence to Anti-diabetic Prescriptions Among Type 2 Diabetes Mellitus Patients in the Kurdistan Region of Iraq.

Treatment adherence is a primary key in controlling diabetes disease. The study aims to determine the prevalence of treatment adherence in type 2 diabetes mellitus (T2DM) patients, investigate the potential influence of adherence on elevated blood glucose levels, and identify the key factors which play a role in non-adherence to the prescribed drugs. A cross-sectional study method was utilized to collect data from all T2DM patients at the Diabetic and Endocrine Centre and Shar Hospital inSulaymaniyah city in the Kurdistan region of Iraq from February 2022 to April 2022. The data collection was performed through a structured questionnaire. The prevalence of drug adherence was assessed using the Morisky Medication-Taking Adherence Scale (4-item), and the glycated hemoglobin test (A1C) was used to determine the blood glucose level. A total of 300 participants were studied, and more than half of them (192; 64%) revealed that they did not adhere to their anti-diabetic medications. Non-adherence was significantly associated with higher A1C. Several barriers to non-adherence were identified as multiple medications, feeling the dose given is high, lack of finance, and side effects by 209 (70%), 116 (39%), 113 (38%), and 103 (34%), respectively. The current study's result revealed that most T2DM patients have no adherence to their medication. This non-adherence is significantly linked to higher A1C levels, emphasizing the critical role of medication compliance in managing diabetes effectively. The study also sheds light on the multiple barriers such as taking multiple prescriptions, the perception that the dose is excessive, lack of finances, and experiencing side effects, which contribute to non-adherence among diabetes patients. These findings underscore the need for healthcare providers to address these barriers and develop tailored strategies to enhance medication adherence among individuals with diabetes.

IDF23-0571 Beneficial effects of an interdisciplinary collaboration in the prescription of cardioprotective antidiabetic drugs

IDF23-0571 Beneficial effects of an interdisciplinary collaboration in the prescription of cardioprotective antidiabetic drugs

De-indexed estimated glomerular filtration rates for the dosing of oral antidiabetic drugs in patients with chronic kidney disease.

Introduction: Adjusting drug dose levels based on equations that standardize the estimated glomerular filtration rate (eGFR) to a body surface area (BSA) of 1.73m2 can pose challenges, especially for patients with extremely high or low body mass index (BMI). The objective of the present study of patients with CKD and diabetes was to assess the impact of deindexing creatinine-based equations on estimates of kidney function and on the frequency of inappropriate prescriptions of oral antidiabetic drugs (OADs). Methods: The prospective CKD-REIN cohort is comprised of patients with eGFR <60mL/min/1.73m2. The inclusion criteria for this study were the use of OADs and the availability of data on weight, height and serum creatinine. We compared data for three BMI subgroups (group 1 <30kg/m2; group 2 30-34.9kg/m2; group 3 ≥35kg/m2). Inappropriate prescriptions (contraindicated or over-dosed drugs) were assessed with regard to the summary of product characteristics and the patient's kidney function estimated with the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the 2021 CKD-EPI equation, the Modification of Diet in Renal Disease (MDRD) equation, the European Kidney Function Consortium (EKFC) equation, their deindexed estimates, and the Cockcroft-Gault (CG) formula. The impact of deindexing the equations was evaluated by assessing 1) the difference between the indexed and deindexed eGFRs, and 2) the difference in the proportion of patients with at least one inappropriate OAD prescription between the indexed and deindexed estimates. Results: At baseline, 694 patients were receiving OADs. The median BMI was 30.7kg/m2, the mean BSA was 1.98m2, and 90% of patients had a BSA >1.73m2. Deindexing the kidney function estimates led to higher eGFRs, especially in BMI group 3. The proportion of patients with at least one inappropriate prescription differed greatly when comparing indexed and deindexed estimates. The magnitude of the difference increased with the BMI: when comparing BMI group 1 with BMI group 3, the difference was respectively -4% and -10% between deindexed 2021 CKD-EPI and indexed CKD-EPI. Metformin and sitagliptin were the most frequent inappropriately prescribed OADs. Conclusion: We highlight significant differences between the BSA-indexed and deindexed versions of equations used to estimate kidney function, emphasizing the importance of using deindexed estimates to adjust drug dose levels - especially in patients with an extreme BMI.

Development of explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A multidisciplinary qualitative study.

The management of type 2 diabetes mellitus patients has changed over the past decade, and a large number of antidiabetic drug treatment options are now available. This complexity poses challenges for healthcare professionals and may result in potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus which can be limited using screening tools. The effectiveness of explicit tools such as lists of potentially inappropriate prescriptions has been widely demonstrated. The aim was to set up nominal groups of healthcare professionals from several disciplines and develop a list of explicit definition of potentially inappropriate prescriptions of antidiabetic drugs. In a qualitative, nominal-groups approach, 30 diabetologists, general practitioners, and pharmacists in France developed explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus. A nominal group technique is a structured method that encourages all the participants to contribute and makes it easier to reach an agreement quickly. Each meeting lasted for two hours. The three nominal groups comprised 14 pharmacists, 10 diabetologists, and 6 general practitioners and generated 89 explicit definitions. These definitions were subsequently merged and validated by the steering committee and nominal group participants, resulting in 38 validated explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs. The definitions encompassed four contexts: (i) the temporary discontinuation of a medication during acute illness (n = 9; 24%), (ii) dose level adjustments (n = 23; 60%), (iii) inappropriate treatment initiation (n = 3; 8%), and (iv) the need for further monitoring in the management of type 2 diabetes mellitus (n = 3; 8%). The results of our qualitative study show that it is possible to develop a specific list of explicit definitions of potentially inappropriate prescriptions of antidiabetic drugs in patients with type 2 diabetes mellitus by gathering the opinions of healthcare professionals caring for these patients. This list of 38 explicit definitions necessitates additional confirmation by expert consensus before use in clinical practice.

Noninsulin antidiabetic prescription patterns in Colombia: a cross-sectional study.

The prevalence of type 2 diabetes mellitus (T2DM) continues to increase; the clinical practice guidelines continue to modify the recommendations for its treatment. The aim was to determine the prescription patterns of noninsulin antidiabetics in a group of patients from Colombia. Cross-sectional study. The use of noninsulin antidiabetic drugs based on a population database of patients under treatment in 2022. Comorbidities were identified, including total numbers, proportions, and defined daily doses of each antidiabetic agent per 1000 inhabitants/day (DHD). A total of 155,381 patients with T2DM were identified, with a mean age of 67.1 ± 12.0 years. The most widely used antidiabetics according to DHD were metformin (9.46 DHD), empagliflozin (5.3), sitagliptin (2.8), linagliptin (2.4), and dapagliflozin (2.3), mainly in combination therapy (55.5%), most often two (31.2% of patients) or three antidiabetics (22.4% of patients). The most frequent cardiovascular comorbidities were hypertension (67.6%), chronic kidney disease (6.3%), and coronary ischemic heart disease (2.5%), treated with angiotensin 2 receptor antagonists, followed by diuretics, calcium antagonists, and β-blockers. This group of patients with T2DM has been treated mainly with metformin alone or in combination with other antidiabetic drugs, but despite the changes in treatment in recent years, a significant number of patients with concomitant cardiovascular conditions are not receiving appropriate antidiabetic agents. Sodium-glucose type 2 cotransporter or glucagon-like peptide-1 receptor agonists may offer additional benefits with reduced cardiovascular risk.

Antidiabetic Therapy during Pregnancy: The Prescription Pattern in Italy.

Pregestational and gestational diabetes mellitus are relevant complications of pregnancy, and antidiabetic drugs are prescribed to obtain glycemic control and improve perinatal outcomes. The objective of this study was to describe the prescription pattern of antidiabetics before, during and after pregnancy in Italy and to evaluate its concordance with the Italian guideline on treatment of diabetes mellitus. A multi-database cross-sectional population study using a Common Data Model was performed. In a cohort of about 450,000 women, the prescribing profile of antidiabetics seemed to be in line with the Italian guideline, which currently does not recommend the use of oral antidiabetics and non-insulin injection, even if practice is still heterogeneous (up to 3.8% in the third trimester used oral antidiabetics). A substantial variability in the prescription pattern was observed among the Italian regions considered: the highest increase was registered in Tuscany (4.2%) while the lowest was in Lombardy (1.5%). Women with multiple births had a higher proportion of antidiabetic prescriptions than women with singleton births both in the preconception period and during pregnancy (1.3% vs. 0.7%; 3.4% vs. 2.6%) and used metformin more frequently. The consumption of antidiabetics in foreign women was higher than Italians (second trimester: 1.8% vs. 0.9%, third trimester: 3.6% vs. 1.8%).

Prescribing patterns of antidiabetic drugs and glycaemic control in type 2 diabetes patients visiting tertiary care hospital based in Karachi, Pakistan

Background: Diabetes mellitus (DM) is a global health concern with elevated blood glucose levels and insulin dysfunction. Our study analyzed antidiabetic drug prescriptions and their effectiveness in managing type 2 diabetes (T2DM) with or without comorbidities. We aimed to gain insights into prescribing practices and efficacy in diverse patient populations. Methods: This retrospective study was conducted at The Aga Khan University in Karachi, Pakistan, over a three-month period. It analysed prescriptions of anti-diabetic drugs for male and female patients aged 18 years and above with type 2 diabetes mellitus. Patient data, including prescribed drugs, diabetes duration, co-morbid conditions, and HbA1c levels, were reviewed using the hospital's Health Information Management System (HIMS). Results: Data from 552 diabetic patients were analysed. The mean age of participants with type-2 DM was 58 years, with 53.3% males and 46.7% females. 25.2% had diabetes for 5-10 years. Good glycaemic control was achieved by 48.7% of patients. Metformin (83.9%), dipeptidyl peptidase 4 inhibitors (DPP4) inhibitors (61.1%), and sodium-glucose transport 2 inhibitors (SGLT2) inhibitors (54.0%) were the most prescribed medications. Three-drug combinations were predominant (41.5%). Conclusions: Metformin was the most prescribed monotherapy for T2DM, followed by DPP4 inhibitors and SGLT2 inhibitors. Common combinations included DPP4 inhibitors with metformin, three-drug combinations with metformin, DPP4 inhibitors, and SGLT2 inhibitors, and four-drug combinations with metformin, DPP4 inhibitors, SGLT2 inhibitors, and sulfonylurea. DPP4 inhibitors were commonly used after metformin due to availability and cost-effectiveness. Glucagon-like peptide-1 inhibitors (GLP-1) analogs were less commonly prescribed due to cost, patient preference, and concerns about side effects.

Five-Year Follow-Up of Diabetic Complications and Geriatric Alterations in French Older Patients with Type 2 Diabetes According to Treatment Modalities: The Observational Prospective GERODIAB Cohort.

Little is known about clinical events occurring in older patients with type 2 diabetes mellitus according to their therapeutic modalities based on the prescription of insulin and/or oral antidiabetic drugs. The aim of this study was to compare the complications of diabetes and geriatric alterations that occurred according to three therapeutic modalities prescribed over 5 years. A total of 616 patients from the GERODIAB cohort (mean age 77.1 years) were divided into three groups: an insulin-only group (n = 200), a group receiving insulin and one or more oral antidiabetic drug (n = 169), and an oral antidiabetic drug group without insulin (n = 247). We compared the diabetic complications and geriatric alterations that occurred over 5 years in patients without these pre-existing complications. At inclusion, there was a significant difference between glycosylated hemoglobin values, and between the frequencies of most diabetic complications and geriatric alterations, with higher frequencies in the insulin group and lower frequencies in the oral antidiabetic drug group. At the end of the follow-up, there was still a significant difference between the mean glycosylated hemoglobin of the three groups (mean for all patients 7.4 ± 0.8%). The frequencies of new clinical events were high and they were generally higher in the insulin group. They were not significantly different between the three groups, with the exception of four events: heart failure, retinopathy, transfer to a nursing home (more frequent in the insulin group), and hypoglycemia (more frequent in the insulin + oral antidiabetic drug group). Some frequencies of the total diabetic complications (including complications at inclusion and at the follow-up) in the oral antidiabetic drug group were close to those in the insulin group, although only at inclusion. Mortality was higher in the insulin group and lower in the oral antidiabetic drug group. The increased frequency of hypoglycemia in the insulin + oral antidiabetic drug group raises doubts about the value of continuing a secretagogue drug when insulin is introduced. As the vast majority of patients were not yet receiving antidiabetic drugs with cardiovascular action, our results on heart failure could help in conducting specific studies on these drugs in older patients with type 2 diabetes.

Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra

Background: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra. Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages. Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination. Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs.